The MetroHealth System June 16, 2016 Presentation to Ohio Joint Medicaid Oversight Committee Dr. James Misak, Vice Chair of Community and Population Health, Department of Family Medicine Susan Mego, Executive Director Managed Care
The MetroHealth System 550 bed tertiary care academic medical center with 27 satellite facilities and an additional 20 sites served through community partnerships 142 primary care physicians 459 specialty physicians 193 advanced practice nurses 37 physician assistants 300+ resident/fellow physicians 1,200 nurses 26,735 discharges in 2015 106,000 ED visits in 2015 Over 1,000,000 outpatient visits in 2015 Affiliated with Case Western Reserve University School of Medicine Special Population Health Expertise: Medicaid, school-based health, corrections, foster care populations, value-based risk-sharing models
Transition to a Value-Based World When entering the payment reform environment and converting from fee-for-service to value-based reimbursement, it is important that providers: Carefully study their book of business Hone their population management approaches Enhance their investments in data analytics and patient engagement resources Transform their business model Continually assess their company culture Larger organizations do not fare any better than smaller entities in adopting these significant changes
MetroHealth s Payment Reform Experience The MetroHealth System has hands-on experience with Medicaid payment reform through multiple initiatives: One of Ohio s largest Medicaid providers Caring for uninsured patients not yet enrolled in Medicaid Operating a successful pre-expansion Medicaid Waiver, MetroHealth Care Plus Supporting the State s exploration of risk-based evolution Designing advanced provider-payer collaborations Managing Medicaid HMO Value Based Total Cost of Care initiatives for CareSource s population
Key MetroHealth Payment Reform Factors Technology and Informatics Single electronic medical record across providers Patients actively using MyChart Among the Most Wired health systems nationally with HIMSS level 7 certification for ambulatory services Patient Centered Medical Home (PCMH) Level III NCQA Recognized Primary Care locations Operational focus on primary care, ambulatory outreach, and the delivery of preventive and chronic disease services Care Coordination interventions tailored to identify and remove multi-source barriers to care for Medicaid beneficiaries Inherent metrics to monitor clinical, quality, and process results
MetroHealth and CareSource Partnership Organizations committed to re-balanced incentives Total Cost of Care contract with first dollar shared savings Population management investments Shared commitment to and shared financial reward for improving selected quality performance improvement measures, e.g. HEDIS Essential layers of collaboration Executive leadership support and expectation of risk evolution Data transparency for population health analysis and planning Co-managed teams focused on making existing initiatives more effective and creating new ones for attributed beneficiaries needs
Realities to Payment Reform Implementation Recognize multi-faceted provider-payer relationships Adding risk-based financials alone will not change the history Essential for provider/payer partners to get re-acquainted for the collaboration s necessary trust and dependencies to occur Leverage collective resources Align incentives between the organizations Expect constant lessons-learned moments and retooling Critical to assist patients with their real-life environments Requires unwavering investment in population health and effective community partnerships Active listening to Medicaid patients & their families as Advisors
How Can The State of Ohio Offer Payment Reform Assistance? 1. Continued support of Office of Health Transformation SIM initiatives: PCMH roll out, Episodes of Care Payment 2. Relieve providers with advanced value based proprietary risk contracts from competing reporting obligations 3. Ensure continuous coverage of Medicaid enrollees to achieve triple aim of improved care, improved population health, lower cost of care 4. Consider legislation requiring minimum percentage of payments from payers to providers be value based, as opposed to traditional fee-for-service payments 5. Facilitate payers claims data-sharing with providers 6. Support of statewide health information exchange
Thank You. Questions or Comments? Presenter Contact Information: Dr. James Misak, jmisak@metrohealth.org, 216-778-3567 Susan Mego, smego@metrohealth.org, 216-957-2659